Preventing Bloodstream Infections and Death in Zambian Neonates: Impact of a Low-cost Infection Control Bundle
Preventing Bloodstream Infections and Death in Zambian Neonates: Impact of a Low-cost Infection Control Bundle
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DOI：
10.1093/cid/ciy1114
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发表时间：
2019-10-15
影响因子：
11.8
通讯作者：
Hamer, Davidson H.
中科院分区：
文献类型：
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作者：
Mwananyanda, Lawrence;Pierre, Cassandra;Hamer, Davidson H.
背景败血症是低资源环境中新生儿死亡的主要原因。随着医院分娩越来越普遍，新生儿因院内败血症死亡的比例也在增加。我们在赞比亚的新生儿重症监护室进行了一项前瞻性队列研究，在那里我们实施了多方面的感染预防和控制（IPC）包，包括IPC培训，短信提醒，酒精搓手，加强环境清洁，以及每周用2%葡萄糖酸氯己定给≥ 1.5 kg的婴儿洗澡。收集集束治疗前6个月和集束治疗后11个月的医院相关性败血症、血流感染（BSI）和死亡率（入院后>3天）结果数据。大多数入组新生儿的出生体重>= 1.5 kg（2131/2669 [79.8%]）。干预期间的医院相关死亡率低于基线期（分别为18.0%和23.6%）。干预期间的总死亡率低于以往各期。半数入组新生儿（50.4%）疑似败血症; 40.8%的培养物呈阳性。大多数阳性血培养产生病原体（409/549 [74.5%]），主要是肺炎克雷伯菌（289/409 [70.1%]）。在干预期间，除婴儿体重外，所有出生体重类别的疑似败血症月发生率和发病密度率均较低
Background. Sepsis is a leading cause of neonatal mortality in low-resource settings. As facility-based births become more common, the proportion of neonatal deaths due to hospital-onset sepsis has increased.Methods. We conducted a prospective cohort study in a neonatal intensive care unit in Zambia where we implemented a multifaceted infection prevention and control (IPC) bundle consisting of IPC training, text message reminders, alcohol hand rub, enhanced environmental cleaning, and weekly bathing of babies >= 1.5 kg with 2% chlorhexidine gluconate. Hospital-associated sepsis, bloodstream infection (BSI), and mortality (>3 days after admission) outcome data were collected for 6 months prior to and 11 months after bundle implementation.Results. Most enrolled neonates had a birth weight >= 1.5 kg (2131/2669 [79.8%]). Hospital-associated mortality was lower during the intervention than baseline period (18.0% vs 23.6%, respectively). Total mortality was lower in the intervention than prior periods. Half of enrolled neonates (50.4%) had suspected sepsis; 40.8% of cultures were positive. Most positive blood cultures yielded a pathogen (409/549 [74.5%]), predominantly Klebsiella pneumoniae (289/409 [70.1%]). The monthly rate and incidence density rate of suspected sepsis were lower in the intervention period for all birth weight categories, except babies weighing